WASHINGTON — New benefits for veterans in Hawai'i, Guam and across the country are being held up in the Senate over cost concerns.

A raft of reforms that U.S. Sen. Daniel Akaka, D-Hawai'i, chairman of the Veterans' Affairs Committee, has been working on for months is now tied up by one of the Senate's most ardent fiscal hawks.

Oklahoma Republican Tom Coburn chose the week of Veterans Day to block the legislation with a Senate procedure known as a "hold."

Many of the blocked reforms are meant to improve the quality, availability and delivery of health care to veterans.

"When Congress votes to send troops to war, we have an obligation to provide them with the care and benefits they need," Akaka said.

The reforms Akaka and many Republicans are pushing would cost $3.7 billion over five years. But lawmakers have not yet found a way to pay for that through budget cuts elsewhere.

Coburn insisted that even the best intentions on Capitol Hill must be paid for.

"I believe we have an obligation to meet the needs of all our nation's wounded veterans," Coburn wrote in a letter to the Democratic Senate leadership. "I do, however, oppose any increase in federal spending that is not paid for, and increases the debt burden on our children."

The deadlock comes as the Department of Veterans Affairs faces new challenges dealing with wounded warriors from two conflicts. Almost 40 percent of the veterans who have served in Iraq and Afghanistan have sought help through the VA health system, with 300,000 reporting mental health conditions. Suicides among veterans who saw combat in Iraq and Afghanistan have spiked in recent months.

OVERRIDE POSSIBLE

For years, government care and benefits for veterans have often been hard to get because of bureaucratic or geographic hurdles. According to Senate testimony from top VA officials, waiting periods on benefit claims are sometimes six months or longer.

"We cannot go on like this," said Ed Edmundson of Illinois, father of soldier Eric Edmundson, who was nearly killed by a roadside bomb in Iraq in 2005 and who now requires the kind of extensive home care some of the new veterans' benefits would cover.

Edmundson's father was in Washington this week to lobby for the new benefits.

"At what point have we sacrificed enough?" he asked.

Senate Democratic leaders hope they can break the deadlock over the benefits package next week with a funding compromise or a vote that simply overrides Coburn's hold.

Meanwhile, the VA's secretary, former Army Gen. Eric Shinseki, has promised to modernize the agency and streamline the delivery of benefits. He has said his top priorities include implementing the new Veterans Educational Assistance Act, which expands educational benefits for veterans who have served since Sept. 11, 2001.

But that program has been late writing checks to colleges where veterans are enrolled, complicating the transition from the military to higher education.

Shinseki has also promised to expand benefits to many middle-income veterans excluded by the Bush administration because they made too much money.

COMMUNITY CARE

Perhaps one of the most daunting challenges the VA faces is providing care to veterans who don't live near VA facilities.

These servicemembers face challenges different from their active-duty counterparts, who typically return to military bases and all the support they provide.

Akaka has suggested that the VA certify health care providers to work in community health centers, eliminating at least some of the travel for veterans. One option blocked by Coburn would expand benefits to cover emergency care for veterans outside the VA system.